Thursday, September 24, 2009

What’s The Return On Fighting Obesity? [Op-ed]

“While recognition of childhood obesity is widespread, solutions to the problem are in surprisingly short supply. Having just closed one of the few pediatric obesity treatment programs in New England, I can identify one of the most cogent reasons for the shortage of such programs: ROI, or the return on investment demanded by health insurers. Our program, Great Moves, was co-founded with health care entrepreneur Stanley Goldstein in collaboration with Children’s Hospital. Families met once a week for five months. The kitchen in the center taught families how to cook. A gym attracted the children with Wii Fit, a version of Dance Dance Revolution, and a Sport Wall. Behavioral counseling was provided as were lessons on such issues as portion size, environmental cues that trigger inappropriate eating, and distinguishing between eating due to hunger vs. boredom. Initial meetings 18 months earlier with the insurance companies had suggested that, if the program worked - that is, for example, if the children’s body mass index numbers started to stabilize or fall rather than rise - insurers would discuss paying part of the program cost. When our first set of children completed the program in the spring, the results were not celebratory but adequate, with 70 percent of the children achieving this modest goal. Insurers responded by saying they would not pay for the program, not because the program did not work but because it did not meet their 12-month return-on-investment goal. This explains why so few programs exist to treat obese children: Sustainable funding for well-designed long-term pediatric obesity programs is nearly nonexistent. Insurers’ limited grants to foundations to support community action against pediatric obesity or their participation in initiatives such as President Clinton’s Alliance for a Healthier Generation do not constitute coverage, but rather goodwill and good public relations. Further, insurer payments to pediatricians to address obesity in their patients are both insufficient and to date largely ineffective. The question then remains: Who will be responsible for addressing - and paying for - the pediatric obesity epidemic? The changes being proposed to the US health care system should encompass long-term return on investment, meaning financial incentives for insurers to address longer-term health problems. Otherwise, the current short-term focus assures that the US health care system will be carrying this heavy burden of pediatric obesity well into the future.”